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JAHA:大血管闭塞性急性缺血性卒中发作后他汀类药物的疗效

2020-11-24 MedSci原创 MedSci原创

急性LVO发作后给予他汀类药物治疗与90天内更好的功能预后和死亡率显著相关。

他汀类药物与急性缺血性卒中患者的复发率降低和功能改善相关。但是,他汀类药物在急性大血管闭塞(LVO)患者中的疗效尚未明确。

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究招募了2420例急性LVO患者,这些患者在发病后24小时内入住日本46个中心。研究人员比较了急性LVO发作后使用和未使用他汀类药物的患者(分别为他汀类药物组和非他汀类药物组)90天时的改良Rankin量表评分。研究人员估计了主要结局的比值比。

该研究排除了12例无LVO的患者和9例无随访数据的患者后,2399例患者的平均年龄为75.9岁,男性占55%。急性LVO发作后,447例(19%)患者服用他汀类药物。他汀类药物组有更多患者出现动脉粥样硬化血栓形成性脑梗死(34.2% vs. 12.1%,P<0.0001),年龄更小(73.4岁 vs. 76.5岁,P<0.0001),以及入院时美国国立卫生研究院卒中量表的中位数更低(14 vs. 17,P<0.0001),相比于非他汀类药物组。他汀类药物组调整后的较低的改良Rankin量表评分总的OR为1.29(95%CI为1.04-1.37;P=0.02)。他汀类药物组90天死亡率(4.7%)低于非他汀类药物组(12.5%;P<0.0001)。他汀类药物组相比于非他汀类药物组的死亡率校正后OR为0.36(95%CI为0.21-0.62;P=0.02)。

由此可见,急性LVO发作后给予他汀类药物治疗与90天内更好的功能预后和死亡率显著相关。

原始出处:

Kazutaka Uchida.et al.Effect of Statin Administration After Onset of Acute Ischemic Stroke With Large Vessel Occlusion: Insights From RESCUE‐Japan Registry 2.J AM HEART ASSOC.2020.https://www.ahajournals.org/doi/full/10.1161/JAHA.120.017472

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  5. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201124/dd06c16d241c4325a5b95bd1a8bd3139/646d17a8fdc14fc087c74bd1e0e468a9.jpg, createdBy=e0ba5276669, createdName=14834267m91暂无昵称, createdTime=Tue Nov 24 19:37:28 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2021-07-30 kkunny
  6. 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    2020-11-27 咻凡

    急性LVO发作后给予他汀类药物治疗与90天内更好的功能预后和死亡率显著相关。

    0

  7. 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encodeId=14281026e16d7, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Tue Nov 24 22:08:43 CST 2020, time=2020-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032717, encodeId=02021032e17ee, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Tue Nov 24 22:08:43 CST 2020, time=2020-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=901882, encodeId=00a69018824b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201124/dd06c16d241c4325a5b95bd1a8bd3139/646d17a8fdc14fc087c74bd1e0e468a9.jpg, createdBy=e0ba5276669, createdName=14834267m91暂无昵称, createdTime=Tue Nov 24 19:37:28 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-11-26 zhaohui6731
  8. [GetPortalCommentsPageByObjectIdResponse(id=2044597, encodeId=206a204459e89, content=<a href='/topic/show?id=644725344b1' target=_blank style='color:#2F92EE;'>#他汀类药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25344, encryptionId=644725344b1, topicName=他汀类药)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Mon Jan 18 08:08:43 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806409, encodeId=71e518064093c, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201124/dd06c16d241c4325a5b95bd1a8bd3139/646d17a8fdc14fc087c74bd1e0e468a9.jpg, createdBy=e0ba5276669, createdName=14834267m91暂无昵称, createdTime=Tue Nov 24 19:37:28 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-11-24 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=2044597, encodeId=206a204459e89, content=<a href='/topic/show?id=644725344b1' target=_blank style='color:#2F92EE;'>#他汀类药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25344, encryptionId=644725344b1, topicName=他汀类药)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Mon Jan 18 08:08:43 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806409, encodeId=71e518064093c, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, 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encodeId=14281026e16d7, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Tue Nov 24 22:08:43 CST 2020, time=2020-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032717, encodeId=02021032e17ee, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Tue Nov 24 22:08:43 CST 2020, time=2020-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=901882, encodeId=00a69018824b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201124/dd06c16d241c4325a5b95bd1a8bd3139/646d17a8fdc14fc087c74bd1e0e468a9.jpg, createdBy=e0ba5276669, createdName=14834267m91暂无昵称, createdTime=Tue Nov 24 19:37:28 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-11-24 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

  10. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201124/dd06c16d241c4325a5b95bd1a8bd3139/646d17a8fdc14fc087c74bd1e0e468a9.jpg, createdBy=e0ba5276669, createdName=14834267m91暂无昵称, createdTime=Tue Nov 24 19:37:28 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-11-24 14834267m91暂无昵称

    学习了

    0

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服用他汀类药物可降低糖尿病患者因COVID-19导致的院内死亡率。如果证实这些结果,则可能会进一步突出在COVID-19期间对糖尿病患者使用他汀类药物的重要性。

JAMA:他汀类药物对高龄老年人动脉粥样硬化性心血管疾病一级预防有益

研究认为,对于75岁以上且基线无动脉粥样硬化性心血管疾病的参与者,开始接受他汀类药物可降低动脉粥样硬化性心血管疾病风险

Diabetes Care:2型糖尿病患者他汀类药物治疗与多发性神经病风险的关系

尽管不能排除很小的急性损伤风险,但他汀类药物疗法不太可能增加或减轻2型糖尿病患者的DPN风险。

NEJM:他汀的肌痛副作用,是真实的吗?

他汀类药物是最广泛应用的降脂类药物,对于预防心梗、卒中,以及它们引起的心血管事件十分重要,是很多一级和二级预防推荐用药,且有大量的证据支持。大多数患者能够耐受他汀类药物,但肌痛、疲劳乏力一直被认为是他

Hypertension:血管紧张素转换酶抑制剂和他汀类药物对1型糖尿病青少年血管的效应

ACE抑制剂可改善高危青少年的血管内皮功能。这种干预在早年的长期保护作用尚未明确。

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